Subepicardial myocardial lesions have been rarely reported, and the spectrum of cardiac diseases resulting in such lesions has not been studied. We examined the hearts of 22 patients who had subepicardial myocardial scars at necropsy. Most (19/22) died suddenly. Atherosclerotic coronary artery disease, cardiac sarcoidosis, acute myocarditis and idiopathic dilated cardiomyopathy were the cardiac diagnoses. Thus, a wide spectrum of disorders is associated with subepicardial lesions.